Antimalarials

Question 1

Potential regimens

Answer 1

• Atovaquone + proguanil
• Chloroquine
• Chloroquine + proguanil
• Mefloquine
• Doxycycline

Question 2

Doxycycline

Answer 2

• 1-2 days before and continue 4 weeks after leaving.
• Protect skin from sunlight/do not use sunbeds
• Do not take indigestion remedies, or medicines containing iron or zinc 2 hours before or after.
• Swallow whole with plenty of fluid during meals whilst standing or sitting.

Question 3

Mefloquine

Answer 3

• Serious NEUROPYSCHIATRIC REACTIONS
• Reports of psychosis, suicidal ideation and suicide
• Prodromal symptoms = abnormal dreams, insomnia, nightmares, depression, anxiety, restlessness + confusion.
• C/I in patients with a history of psychiatric disorders and convulsions.
• Counsel patients to stop + seek medication attention to replace with alternative if this occurs.

Question 4

Mefloquine + driving

Answer 4

Can cause dizziness and disturbed balance.
Long half-life - may persist up to several months after stopping

Question 5

Risk

Answer 5

High risk - malarone, doxycycline or mefloquine
Low risk - chloroquine

Question 6

Length of prophylaxis

Answer 6

Atovaquone + proguanil
- 1-2 days before
- 1 week after

Chloroquine
- 1 week before
- 4 weeks after

Chloroquine + proguanil
- 1 week before
- 4 weeks after

Mefloquine
- 2-3 weeks before
- 4 weeks after

Doxycycline
- 1-2 days before
- 4 weeks after

Question 7

Long-term prophylaxis

Answer 7

> 5 years = chloroquine + proguanil
2 years = doxycycline
1 year = mefloquine or malarone

Question 8

Epilepsy

Answer 8

Avoid chloroquine and mefloquine

Question 9

Renal impairment

Answer 9

Avoid proguanil

Question 10

Renal impairment (eGFR <30 ml/min)

Answer 10

AVOID malarone + chloroquine
CHOOSE doxycycline or mefloquine

Question 11

Pregnancy

Answer 11

Chloroquine + proguanil + folic acid 5 mg

Doxycycline = C/R
Avoid mefloquine (manufacturer)
Avoid malarone (no alternative, give in 2nd/3rd)

Question 12

Warfarin

Answer 12

Enhances anticoagulant effect.
Start prophylaxis 2-3 weeks before
INR must be stable before departure
Monitor INR:
- Before treatment
- 7 days after starting
- After completion
Prolonged stays = check INR regularly

Question 13

Summary

Answer 13

Question 14

Malaria - diagnosis

Answer 14

Any illness that occurs within 1 year (esp first 3 months) - see GP immediately and mention malaria exposure

Question 15

Treatment

Answer 15

Falciparum malaria
- Quinine
- Malarone
- Riamet

Non-falciparum malaria
- Chloroquine

Question 16

Quinine

Answer 16

• Standby treatment of malaria
• Take if you cannot access medical care in 24 hours of fever onset.
• Given with written instructions that urgent help is required if fever >38, 7 days or more after arriving in malarious zone.